executivecommitteeof workingpartyof
the directingcouncil the regional committee
PAN AMERICAN
WORLD
__'
HEALTH
HEALTH
ORGANIZATION
ORGANIZATION
116th Meeting Washington, D.C.
June 1995
i ii ii
Provisional Agenda Item 4.12 CEl16/27 (Fag.)
8 May 1995
ORIGINAL: ENGLISH
EMI_RGENCY PREPARmr)NESS AND DISASTER ltELri_._ iii
i i mm
The Emergency Pr_are_ess and Disaster Relief Coordination Program (P_) of PAHO has a dual mandate: to provide technical cooperation to the health sector of the Member States in disaster preparedness, and to assess health needs and coordinate postdiaaster relief.
This document outlines the evolution of this mandate over the last 18years: to include disaster mitigation activities as well as preparedness, to extend the Program's reach to other sectors which impact health, and to coordinate health relief in complex disasters.
C
E
l1
6/
27
(
F
ag.)
P
a
g
e
2
CONTENTS
Page
Executive Summary
...
3
1
.
Introd
u
cti
o
n
...
4
2
.
T
e
chnical Coop
er
a
t
ion
Pr
ovid
e
d by
P
A
H
O
/
W
H
O b
e
for
e
th
e
Onse
t
of Di
s
as
t
er ...
4
2.1
Institutional St
r
engthenin
g
...
4
2.
2
D
e
velopm
e
n
t
of
H
uman R
e
sour
ces
...
6
2
.3
Coordinati
o
n a
n
d
L
iai
s
on
w
ith Other Ag
e
ncie
s
...
7
2
.4
Le
s
s
on
s Le
a
rne
d and
P
ropos
e
d A
c
tion ...
8
3.
PA
H
0
/WH
0
Ro
le in
Hu
m
anitarian
As
s
i
s
ta
n
ce ...
9
3.1
E
xp
e
rienc
e
...
9
3.2
Le
s
sons Lea
r
ned and Pr
op
osed Action ...
13
3.3
Ha
iti Int
e
rag
e
ncy
E
valuation ...
14
C
E
116
/
27 (
E
ng
.
)
P
a
g
e 3
E
X
E
CUTIV
E S
UM
M
ARY
T
echnical c
o
ope
r
ation
p
rovi
d
e
d
by PA
H
O
/
W
H
O c
o
vers tw
o
i
m
portan
t
ar
e
a
s
:
disas
t
er prepare
d
ne
ss
a
n
d coor
d
i
n
ation of disaster relief
.
Ov
er
t
h
e yea
r
s
, P
A
H
O
/
W
H
O
h
as expande
d
its focus from natu
r
al disasters to a multihazard a
p
proa
ch
that includes
tec
h
nological disasters and complex emergencies
s
uc
h
as those resulting from civil
con
f
lict
.
PAHO
/
W
H
O
h
as also extended its reac
h
beyond the
h
ealth se
c
tor to include
other key sectors suc
h
as civil
d
efense and
p
ublic wor
k
s, and, more re
c
ently
,
parliam
en
tarian
s
an
d
ministri
es o
f f
o
re
i
g
n
affair
s
.
Th
e
sc
o
p
e
of a
c
tiv
i
tie
s h
as s
h
i
f
ted
from prepared
n
ess to preve
n
tio
n
of damage to health sector facilities
.
T
his broade
n
ed
scope is closely associated with the
p
rog
r
essi
v
e in
c
lusion o
f
technical co
o
peratio
n
o
n
disaster ma
n
ageme
n
t as the
p
rime respo
n
sibility of t
h
e Organizatio
n
's
r
eprese
n
tatives and
a cooperative effort by all
r
egional
p
rog
r
ams
.
The Organ
i
zation
w
as req
u
es
t
ed to ta
k
e a
mo
re dire
ct o
pe
ra
tionalrole in
c
o
mp
lex
disasters
.
T
he most notable exam
p
le was PA
H
O's leading role in the delive
r
y of
h
umanitarian assistance to
H
aiti since
D
ecem
b
er 1991 in the effo
r
t to keep t
h
e
h
ealth
situation from deterio
r
ating even further as a result of economic sanc
t
io
n
s
.
A
c
tivities
d
uring the e
m
barg
o
inclu
d
e
d
es
tab
li
sh
ing an es
s
ential drugs and
m
e
d
i
c
al sup
p
lies
c
en
t
er,
distributing fuel to organizatio
n
s invol
v
e
d
in
h
umanitarian assis
t
an
c
e
,
and organizing
h
umanitarian
fl
ig
h
ts to
c
ontinue the
fl
ow o
f
esse
n
tial
p
ro
d
ucts to the
p
opulatio
n.
A
s
trategic evaluation
of
PAHO
/
W
H
O'
s h
u
m
anitarian a
s
sistanceactivities in Haiti
carried out joinfiy by the Off
i
ce of U
.
S
.
F
oreign
D
isas
t
er Assis
t
ance (
U
SAI
D/
OF
D
A)
,
t
h
e Canadian Inte
r
national Development Agency (CI
D
A)
,
and PA
H
O
/
W
H
O revie
w
ed the
lessons learned and offere
d
some recommen
d
ations
.
Th
e team also suggeste
d
t
h
at the
G
over
n
in
g
Bodies reaff
um
the importan
c
e
of
hu
mani
t
a
r
ian as
s
istan
c
e in
the
Organizatio
n
's missio
n
and PA
H
O's
c
oordinating role in all
h
ealth matters
.
F
inally, the
evaluatio
n
report raised questio
n
s
c
on
c
erning the devastating e
ff
ects of a full
,
pr
olo
n
ged
embargo on the
h
ealt
h
o
f
the poorest seg
m
e
n
ts of t
h
e po
p
ulatio
n.
P
A
H
O
/
WHO s
h
ould
advocate that measures be adopted to minimize the negative impact o
f
inte
r
natio
n
al
economic sanctions on pu
b
lic
h
ealt
h.
CE116/27 (F,ng.) Page 4
1. Introduction
Overwhelmed by a string of sudden-onset disasters that claimed the lives of almost 100,000 persons in the Region of the Americas inthe first half of the 1970s, the Directing Council of the Pan American Health Organi?otion at itsXXIV Meeting in 1976 approved Resolution CD24.R10, instructing the Director to set up a disaster unit within the Pan American Sanitary Bureau.
Since its inception in 1977, the Emergency Prep_ness and Disaster Relief Coordination Program (PED) has evolved considerably in order to adjust to changing needs at the regional level and to new approaches and trends atthe global level. For instance, it is now recognized that a multihazard approach to disaster preparedness and response is essential nationally and internationally. PAHO/WHO's Member States endorsed this approach in Resolution CD27.R40 of the XXVII Meeting of the Directing Council in 1980, and mandated the Secretariat to provide "technical cooperation and coordination in preparing the health sector to respond effectively to health problems caused by technological disasters, such as explosions andchemical accidents, as well as by displacements of large population groups caused by natural or manmade disasters." 2. Technical Cooperation Provided by PAHO/WHO before the Onset of
Disasters
2.1 Institution Strengthening
A priority of the Organi?ation is to contribute to the development and strengthening of a disaster management program in the ministries of health of Member States, thereby preparing the health sector to respond promptly and effectively to emergencies caused by disasters. The national official in charge of this program is the counterpart of the Organization and will determine the priority areas for technical cooperation. Today, practically all ministries of health in the Region have designated a unit or professional to oversee disaster preparedness activities in the health sector.
CE116
/
27 (
En
g.)
Page
5
p
a
rli
am
ent
ar
i
an
s
a
t
na
ti
onal
, subr
e
gi
on
al
,
and regio
n
al levels f
or
the putt_
o
se of
a
ssisti
n
g
t
he revisi
on o
f c
r
itical dis
a
s
t
er-rel
a
te
d
legislati
on
; t
o
mi
n
is
tr
ies
o
f f
o
reig
n affa
i
r
s t
o
prep
are
thei
r
c
on
sul
a
r
an
ddi
p
l
o
m
a
tic
pe
rs
on
nel
,
d
e
v
e
l
opre
s
pon
se guideli
n
es
, an
di
n
clude
dis
a
s
t
er m
a
n
a
geme
nt
in
th
e cu
rr
ic
u
la
of
di
p
l
o
m
a
tic
a
c
a
de
m
ies; t
o
pr
of
essi
on
al
a
ss
oc
i
a
ti
on
s
(e
n
gi
nee
rs
,ar
c
h
i
te
c
t
s,
p
l
ann
ers)s
o
t
hat
t
h
ey
ma
ypl
a
y
a
de
t
er
m
i
nant
r
o
le i
n p
reve
n
ti
n
g
t
he effec
t
s
o
f
na
tur
a
l
d
is
a
sters
o
n
hea
lt
h fa
ciliti
e
s and h
o
usi
n
g.
I
n
itially
,
PA
H
O
/
W
H
O f
o
c
u
se
d on
impr
o
ving th
e
re
a
di
ne
ss
of
the
h
ealth s
e
ct
o
r t
o
resp
on
d pr
o
mptly and efficie
nt
lywh
en
dis
a
s
t
er stri
k
es (i.e.
, p
rep
a
red
n
ess).
T
he dr
ama
tic
c
o
ll
a
pse
o
f t
h
e Juirez H
o
spit
a
l i
n
1985 in Mexic
o
br
o
ug
ht to li
gh
t
the
fa
ct t
h
a
t
well-t
ra
i
n
e.
A
h
o
spit
a
l p
e
rs
on
nel an
d
well-t
e
sted instituti
ona
l disast
e
r
p
l
an
s
are of
littleuse if
the buildi
n
gs t
h
e
m
selves d
o no
t withst
and
the dis
a
s
t
er
'
s im
pa
ct.
Th
us
,
PA
H
0
/
W
I
-IO's
focus
w
as
e
xpanded to
a
ddress di
sa
s
te
r preve
n
ti
o
n
/
mitigation for h
ea
lth faciliti
e
s. N
o
un
ivers
a
lly
a
cc
ep
ted
p
ri
n
c
ipl
es g
o
vern i
n
frast
r
uctur
e
buil
t
by
na
ti
on
al aut
ho
riti
es an
d
fu
nde
d b
y
bi
lat
era
l
a
g
en
ci
e
s
o
r
m
ul
ti
l
a
te
r
a
l ban
k
in
g ins
titution
s.
To al
l
evia
t
e thi
s
problem,
P
ED will
or
ga
n
ize a regio
n
al confere
n
ce i
n
early 1996 on disast
e
r mitigatio
n
fo
r
ho
spital
s
an
d h
ealth f
a
ciliti
e
s. Th
e ob
jectiv
e of
this c
o
nfere
n
c
e w
ill be to
p
ro
mote
th
e
adoption of earthquake a
n
d wind resistanc
e
features in n
e
w a
n
d exi
s
ti
n
ghealth faciliti
e
s.
P
Al-lO technical cooperation i
s
promoting th
e
adoption at
n
atio
n
al l
e
v
e
l of th
e
multihazard approach u
n
d
e
r which vul
ne
rability analysi
s
, prepared
n
ess
,
and respons
e
to
all types of disast
e
r are th
e
respo
n
sibility of a sin
g
l
e
disast
e
r unit r
a
th
e
r tha
n
of se
ve
ral
speciali?ed technical d
epartment
s.
CE116
/
27 ('Eng.)
Page 6
2
.
2
Developmentof Human Resources
In addition to strength
e
ning health sector institutions in the Me
m
ber States, the
d
e
v
e
lopm
e
nt of human resources has also been a corn
e
rston
e
of PAHO
/
WHO. This
strat
e
gy has been accomplished by training ia the form of workshops in disast
e
r
preparedn
e
ss
,
mitigation, and prev
en
tion; producing
w
ritten and audiovisual training
materials; and
e
stablishing th
e
means of disseminating information to disast
e
r managers
throughout th
e
Region.
2.2.1
TrainingandEducation
Annually, P
A
HO
sup
port
s
an average o
f
200 trai
n
ing activities o
n
disaster
ma
n
ageme
n
t ia Lati
n
America and the Caribbea
n
.
F
ro
m
its earliest stag
e,
the Program
involved the civil de
f
e
n
se
,
fh'e and police departmen
t
s
,
the
R
ed Cross, an
d
other NOOs
ia health s
e
ctor prepared
n
ess activities. Gradually, these initiatives were take
n
over by
nati
o
nal authoriti
e
s, to the point that today i
t
is diffic
u
lt to keep abreast o
f
many o
f
the
local and national training activities in the Region. The result has been bett
e
r-prepared,
multisectoral disaster managem
e
nt teams at th
e
national level.
Universities in Latin America and the Caribbean are critical to ed
u
catio
n
in
disaster preparedness and mitigation. During the 1980s, a substantial number of faculties
of public health, medicine, and nursing included this subject in their curricula. Many of
those efforts were coordinated by the WHO Collaborating Center at the School of Public
Health of the University of Anfioquia ia Medellfn, Colombia. These efforts must
continue and efforts also focus on the inclusion of a disaster mitigationcu
r
riculum in
schools of engineering and architecture.
2.2.2
Production of Training Materials
The develop
m
e
nt
and pro
d
uction
of
training and ed
u
cational
m
aterial has had a
major "multiplier" effect. In the last decade, countries have been encouraged to either
adapt PAH0
/
WHO publications
,
slide series
,
and video programs to their particular
situation, or to prepare original materials which can be shared with countries with similar
vulnerabilities. This
m
aterial has been disseminated widely in La
t
in A
m
erica and the
Carib_.
CE116/27 (F.ng.) Page 7
2.2.3 Dissemination of Information
Despite the fact that a great deal of technically and scientifically important material on disaster prevention, mitigation, and preparedness is produced in Latin America and the Caribbean, much of this material is not being utilized, either because few people know it exists or because it is inaccessible. To address these problems, in
1990 PAI-IO_O created the Disaster Documentation Center ia San Jos6, CostaRica. The Center has collected and indexed approximately 6,000 published and unpublished reports, periodicals, books, and other material related to disasters. The material is disseminated, free of charge, to disaster professionals throughout the Region. It has become increasingly difficult tokeep up with the demand for information, in part because the Center has actively promoted its services. Therefore, PAItO/WttO has sought partners tomaintain and build upon the momentum generated by a cadre of mulfisectoral
disaster professionals in the Americas.
Communications technologies are important tools for managing the large and varied human resources and information needs of the Region. Since the mid-1980s, ?AHO/WttO has made extensive use of local area networks, database systems, and, more recently, electronic mail. The Disaster Mailing List database, used todistribute the quarterly newsletter on disaster preparexlness and mitigation issues, has grown from 7,500 to 23,000 in the last six years, and the quality has been maintained thanks to its decentralized maintenance at subregional level. This database is linked to five specialized lists: donors, the International Decade for National Disaster Reduction (IDNDR), hospital mitigation, the Relief Supply Management Project (SUMA), and the Disaster Documentation Center. PAttO/WItO also maintains a roster of disaster experts and a list of meetings and training activities.
In a soon-to-be-launched project, funded by NASA, PAItO will link (via the Internet or other means) health and other multisectoral agencies in Central America with other national and international disaster management partners outside the health sector in an electronic disaster preparedness network and with an interagency Worldwide Web disaster site.
2.3 Coordination and Liaison with Other Agencies
CE116/27 (Eng.) Page 8
sector. It isalso worthwhile to note theproposal made to UN/D/IA to establish a formal disaster management partnership in this Region based on the model of ongoing cooperation between PAH0 and the IDNDR. The IDNDR Secretariat established a regional office for Latin America and the Caribbean in San Jos6, Costa Rica, assigning a fuU-time officer to that post. Local costs are shared between the two parties.
The Emergency Preparedness Program, in close cooperation with PAHO's Division of Health and Environment (HEP) and its the Center for Human Ecology and Health (ECO), the International Program on Chemical Safety (ICPS), and the United Nations Environmental Program (UNEP), used modest core resources to raise health sector awareness of vulnerability to chemical and radiological accidents. Now that the Member States have given priority to their need for preparedness for technological
accidents, this component of the program will call for additional resources and interagency coordination to respond to what may become the principal hazard in the 21st century.
In humanitarian assistance, PAH0's main partners are WHO/HQ, theRed Cross, and other NG0s. The overall coordinating role of UN/DHA is unequivocally supported by the Organization, which looks to it for global policy guidance and multisectoral coordination. Efforts are also being made to strengthen PAH0's relationship with the Armed Forces of the United States and other industrialized countries because of their increasing role in humanitarian operations.
Another important strength of the Program is its excellent collaboration with bilateral agencies in Member and Participating States (CTDA/Canada, ODA/United Kingdom, and AID/USA) and outside the Region, particularly the Humanitarian Office of the European Union (ELY)and agencies of the EU's Member Governments.
2.4 Lessons Learned and Proposed Action
In spite of a marked shift of attention and resources at international level towards the more "fashionable" issue of complex disasters, PAH0/WHO willmaintain a balanced approach between natural, technological, and manmade hazards that reflects the needs and priorities of the Region.
PAH0/WHO will continue to extendits technical cooperation to othersectors that can assist the health sector in its mission to reduce the negative impact on health from disasters.
PAH0/WHO will assist the countries to benefit from the 'information superhighway" by helping in their access to electronic information and networking
C
E
116
/
27 (
F
lag.)
Pag
e
9
Within the Organization, the Office
o
f the PAl-lO
/
WHORepresentative (PWR)
,
rather than a specialized regional program, should assume primary re
s
pons_ility for
technical cooperation in disaster management.
During the la
s
t five years, every
Repre
s
entative's Of
f
i
c
e has de
s
ignated a
s
taff membe
r
a
s
the disaster "focalpoint." These
focal points are now
f
n-st-li
n
e providers of technical cooperation, working with the
Ministry of Health to identify priorities for action. This policy ha
s
been reinforced by
a dire
c
tive spelling out the respons
i
bilitie
s
of the various institutional levels in the
provision of technical cooperation in disaster prevention, mitigation, a
n
d preparedness.
Appropriate activities should be planned as part of country pr
o
ng
exercises, and should be funded at a level compatible with the vulnera
b
ility of the
count
r
y, independent of the fluctuating regional extrabudgetary contribution.
At
the
regional level, other PAHO
/
WHO programs should include technical
c
oopera
ti
on
a
ctivitiesto redu
c
e vuln
e
rability to natural an
d t
echn
o
l
o
gical di
s
a
s
t
e
rsin th
e
ir
respective areas of responsi
b
ility.
3.
PAttO
/
WItO
Role in ttumanitarian
Ass
i
stance
In the 1990s, the Organization was called on to provide an operational respon
se
to long-lasting "com
p
lex_ disasters re
s
ulting from conflicts or politicalcollapse. PAI-IO's
experience in re
s
ponding to such emergencies in Nicaragua, El Salvador, and I-Iaiti is
highlighted
below.
3.1
Experience
3.
1
.1
Nicaragua
CE! 16
/
27 (
E
ng.)
Page 10
3.1.2
ElSalvador
After th
e
signing
o
f the January 1992
p
eace acc
o
rd betwee
n
the
G
overnment
of
E1 Salvad
o
r and th
e
'Frente Farabundo Marff para la Liberaci
6
n N
a
cional" (FM
L
N-)
,
PAI-IO_O
t
ook re
s
po
n
sibility for
m
aintaining health
s
ervices in 18 camps that had
b
ee
n
esta
b
lis
h
ed
t
o
f
acilitate the de
m
obilizati
o
n
of
fi
g
hting
fo
rces and the rein
t
egrati
on
of
c
om
batants an
d
their families in
to s
ociety. PA
H
O
/
_O
pr
ovi
d
ed the
s
ervices o
f
66
h
ealth pro
f
ess
io
nals w
ho
co
nd
ucted
m
ore than 60
,
000
m
edical an
d
de
n
tal exams, and
gave specialized treatment in over 6,000 instances
.
3.1.3
Ha/t/
The m
ost n
otable example of
P
AHO
/
W
H
O involve
m
en
t in
humanitari
a
nas
si
stance
activities began
f
ollo
win
g the military co
u
p in
H
aiti in September 1991. At that time,
PAI-IO
/
W
H
O
p
layed a
m
aj
o
r ro
l
e as
t
ech
n
icalco
o
r
d
inator
of
the OASmis
s
io
n
toassess
needs for humanitarian assistance in December 1991.
La
t
er, to addre
s
s the crisi
s
-accel
e
rated deterioration in the co
un
try, PAItO
assumed the leading role in the coordination of all health humanitarian assistance, and
provided direct support (finance,
logistical) to maintain key public health programs:
maternal and child health; control and prevention of communicable diseases; essential
drugs; water supply and sanitation--that
is, in essence, the maintenance of any life-saving
health activity.
P
A
H
0
/
W
H
0 als
o
played a
ma
j
or
role in Haiti in the form
u
lation of policies and
strategies and the coordination
of external assistance.
During the three-year crisis
,
PAItO
/
W
H
O exercised this leadership function through:
-
the organizatio
n
of a "
H
ealth Coordination Committee" with the Co
n
stitutional
health authorities, UN agencies, NGOs and donors;
-
th
e compilati
o
n and p
u
blicati
o
n o
f
an ann
u
al survey
of
t
h
e
h
ealt
h s
ituation (ia
three languages);
-
formulation o
f a m
aster plan for funding an
d
impleme
n
tation by multilateral
donors such as the European Union's Humanitarian Office (EC
H
O);
-
lau
n
ching of periodic in
t
ernational appeals
t
o
d
onors.
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Page 11Under the humanitarian program in Haiti, several projects stand out either for their long-term importance, such as the essential drugs and supply provision system (PROMESS) (an essential drugs and supply center), or for their inclusive nature, such as the Humanitarian Fuel Program (PAC) orthe Humanitarian Flights Project (PAT).
PROMESS (Programme d'approvisionnement en mddicaments essentiels). The political crisis and the subsequent embargo exhausted, or at least considerably reduced, the availability of essential drugs and basic medical material. To alleviate this situation, PAHO/WHO created PROMF_3S, a central supply service which maintains the essential drugs listed by WHO (approximately 270), plus basic medical supplies. This program has stabiliTed prices for medical supplies in the Haitian market, and provided medicaments to more than 500 institutions. In addition, PROMESS ensures the free and constant availability of vaccines and syringes, anti-tuberculosis medicines, oral rehydration salts, contraceptives, and vitamin A for all health institutions. PROMESS is also responsible for the free donation of essential drugs, basic medical material, and edible products for selected health institutions within the framework of humanitarian assistance.
Of the 660 health institutions, 520 have received subsidies totaling USS 2.3 million, and more than 3,500 deliveries, with a total value of $4 million. Currently, the available stock at PROlVIF_3Sisvalued at $2 million. Most significant isthe importance of PROMESS as a self-sustained procurement and distribution mechanism of essential drugs and supplies for future health activities in Haitiman unusual contribution of humanitarian emergency assistance to development.
PAC-Humanitaire (Programme d'approvisionnement en
combustible).
When the United Nations reimposed a fuel and weapons embargo on Haiti in October 1993, donors and humanitarian assistance organi?ations feared that the shortage or absence of fuelwould bring their humanitarian activities to a standstill. Faced with this prospect, in December 1993 the Organization of American States and the United Nations jointly asked PAHO/WHO to establish a management structure for fuel distribution to all humanitarian assistance programs. This Program became "PAC-Humanitaire."
A Fuel Management Committee was convened to oversee the project, comprised of representatives from the UN, OAS, PAHO/WHO, the Constitutional Government of Haiti, key donors, one oil company, and representatives of NGOs. The purpose of the Committee was to provide overall policy guidance and to determine eligibility for fuel allocations. The Management Committee, not PAHO/WHO, decided how to allocate fuel, following strict humanitarian assistance criteria. Of 625 applicants, 324 agencies were approved by the Committee.
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of health services, water systems, food distribution, and other critical lifesaving activities.
In the critical initial phase, costs were covered by donations from the U.S. Government, CIDA/Canada, Denmark, and the European Union. Later, the project became serf-sufficient, and operational costs were covered by the proceeds from the sale of fuel to authorized users. Although each recipient agency assumed responsibility and accountability for the proper use of the fuel, PAHO/WHO monitored the situation closely to detect any possible abuse. No major incidents have been reported.
Humanitarian Flights. Following the suspension of commercial flights to Haiti inJune 1994, and atthe request of the U.S. Government and in consultation with the UN and OAS, PAHO/WHO accepted responsibility for organizing chartered flights from Miami to Port-au-Prince on behalf of all interested agencies.
This project clearly needed from a health point of view--encountered considerable administrative difficulties. A first flight of emergency supplies for a meningitis outbreak was delayed repeatedly (for more than four weeks) by the process of securing all necessary clearances, waivers, and liability insurance from the UN, the U.S. Government, and the de facto Government in Haiti.
Through 24 October 1994, nine flights delivered 163,682 pounds of freight, mostly medical supplies, from PAHO/WHO. Although the plan did foresee that UN/DHA would make all arrangements for distinct passenger flights, the pressing need of humanitarian agencies led PAHO/WHO to include 148 humanitarian personnel on some of its later flights.
Implementation of SUMA. In all humanitarian assistance operations, managing incoming relief supplies and pledges from the donor community needs specialized attention. PAHO/WHO placed the services of aregional team of expertsfrom its SUMA Project at the disposal of UNDP, UN/DHA, and theHaitian authorities. Rapidly, SUMA provided services far beyond the inventory and classification of supplies to include
management of pledges, unloading of humanitarian flights, temporary storage, customs clearance, and repackaging, as necessary, for distribution. This expertise of PAHO/WHO Member States could be valuable to the UN in both naturaland complex disasters outside the Region.
The experience that PAHO/WHO has gained in Haiti is, most likely, unique: - Three years of exclusive dedication to short-term humanitarian assistance. As a
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Page 13- No formal collaboration/contact with the de facto government and health authorities--an unusual situation for an agency whose principal interlocutor is normally the Ministry of Health.
- Reliance on local and international NGOs as implementing parmers. This very satisfactory experience should change, for the better, the overall relationship of PAHO/WHO with NGOs.
- Economic sanctions adversely affecting the poorest segment of the population and unnecessarily hampering the ability of humanitarian agencies to deliver goods and services specifically exempted by the sanctions.
- As the main humanitarian player in Port-au-Prince, PAHO/WHO became the logical, if not the only choice for critical activities normally falling outside traditional health programs: distributing fuel and running a charter service. An interagency strategic evaluation of PAHO humanitarian activities was undertaken in February 1995 by USAID/OFDA., CIDA and PAHO/WHO to draw the administrative, technical, and policy lessons learned and suggest ways and means to improve future humanitarian activities. The formal report of the evaluation was submitted to the Director of PAHO by Mr. Branford M. Taitt, Chairman of the Evaluation Team, on 30 March 1995. A copy of the Evaluation Report is available to members of the Executive Committee.
3.2 Lessons Learned and Proposed Action
The response of PAHO/WHO and the Region to recent emergencies has been effective only because of its strong tradition of disaster preparedness. PAHO/WHO does not have a disaster response team, it has a disaster preparedness program which occasionally is activated in a response mode. The priority of the OrganiTation should remain the provision of technical cooperation in disaster prevention and preparedness. PAHO/WH0 involvement in the operational delivery of humanitarian assistance should be considered only when the Organization has a strong comparative advantage orunique capability.
Global UN response plans make little provision for meaningful local participation. There is a risk, if not a tendency, of applying the model of intervention of Somalia or Rwanda, where external (UN or bilateral) teams are seen as _the solution" to all emergency situations. PAH0/WHO should continue to advocate national self-reliance through preparedness and training rather than the intervention of international
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WHO, and PAffO in this Region, has the overall responsibility of coordinating the entire scope of health assistance--humanitarian and otherwise. This mandate within the UN system is not always clearly recognized by the UN humanitarian assistance coordinators. PAHO_O responsibility is often confined by the UN coordinator to just a segment of its health mandate. This responsibility is particularly critical atthe time of launching a UN appeal. PAtiO/WHO should assert its mandate to formulate priorities and a comprehensive strategy for all health activities including nutrition, sanitation, etc. However, responsibility for implementation and fund-raising shouldclearly be shared among the various partners.
In December 1994, the UN General Assembly adopted a resolution (A/49/L. 19) encouraging countries to develop national volunteer corps, the so-caned 'White Helmets," to assist the UN, among others, in the fight against poverty and the delivery of humanitarian assistance. PAHO_O is supporting the active participation of Latin American and Caribbean nationals in humanitarian programs following international
disasters. PAHO/WHO may assist Member States in the training of volunteers (for instance in Supplies Management-SUMA, the dissemination of health information, and other forms of technical cooperation).
Although a trend toward the centralized management of response to complex emergencies seems to be gathering momentum at the global level, the effectiveness of the Organization's response will continue to depend, to a large extent, on the local competence and knowledge of the situation. Thus, the role of the PWRs iscritical and more emphasis must be placed on the training and readiness of local staff who axebest able toassess the fast changing conditions, respond flexibly, and deliver services within the overall political framework determined at the central level. The key role ofthe PWR offices and the need for flexible, decentralized management of humanitaxian activities is recognized by the PAHO/WHO Secretariat.
3.3 Haiti Interagency Evaluation
The Haiti Interagency Evaluation Team offered extensive recommendations to improve PAHO institutional capacity and facilitate action intimes of political crisis. The full text of the report is available. Selected recommendations proposed that:
(a) PAHO/WHO design and implement an administrative procedures manual especially adapted for emergency situations. It should focus on decentralized decision-mala'ng, effectiveness and speed of the purchasing process, andfiexibility in local contracting.
c
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Page 15PAHO realizes that humanitarian activities have created a new challenge for quick, innovative decision-making under conditions of uncertainty, forwhich the present rules and procedures are not adapted. In Resolution 46/182, the UN General Assembly noted: "Special emergency rules and procedures should be developed by the UN to enable all organizations to disburse emergency funds quickly and to procure emergency supplies and equipment, as well as to recruit emergency staff." Jointly with the Interregioual Task Force established by WHO, PAHO willreview existing administrative and financial procedures governing emergency operations with a view to improving timeliness of response, standing procedures, and increased flexibility and delegation of authority to the field.
(c) PAl-lO/WHO arrange, in prolonged crisis situations, for the creation at Headquarters of a special management unit with the power to offer timely responses to situations.
Such anadhoc group established late in the Haitian crisis proved to be a valuable management solution, likely to be adopted in s'unilar situations.
(d) PAl-lO/WHO be authorized to provide assistance to public sector institutions directly involved in the delivery of essential services to vulnerable populations, notwithstanding other considerations.
(e) In case of an embargo, Member States agree to provide PAHO/WHOwith broad waiver facilities so that it can properly carry out its mission.
The impact of the sanctions on Haiti has been twofold:
- First, the sanctions have directly impacted the population. The resulting deterioration of health services and the health situation, already the most underdeveloped in the Region, was only slowed by the generous support of the international community, channeled inpart through PAHO/WHO.
- Second, the sanctions increased the complexity that humanitarian agencies faced in providing the needed services or supplies. Although exempt from the embargo, medical supplies were, forinstance, delayed by alack of appropriate transport or other formalities. The example of the four-week delay of the fu_t humanitarian flight chartered by PAHO/WHO, a UN specialized agency, illustrates the operational difficulties encountered by all humanitarian organizations.
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of these unintended health consequences could and should be prevented by blanket exemption toUN humanitarian agencies from the cumbersome process of item-by-item clearance by UN and national authorities.
The Evaluation Team also recommended that:
(f) Member States recognize the intervention capacity of PAHO/WHOin emergency situations and make it an essential element of PAHO/WHO's mission.
(g) On the basis of the Haitian experience, PAHO_O's role of coordinating emergency interventions in the field be rea_rmed by Member States and recognized by other agencies and international organizaa'ons.
(h) PAHO/WHO draw from the Haitian experience as regards working with the private, non-profitsector (N_s) ; establishing durable organizations (PROMESS);
and using cost-recovery systems. 4. General Conclusions
The humanitarian response of PAHO/WHO to complex disasters has become a new facet of the OrganiTation's Emergency Preparedness and Disaster Relief Coordination Program. This pwgram has evolved considerably over the last 10 years. From a Program with an operating budget of approximately USS 25,000 in 1977, the Program has, for the last five years, had an annual budget of $2.1 million. Requests for technical cooperation and support in the expanded area of disaster management and reduction are fast outpacing the existing resources, 9096 ofwhich are extrabudgetary. On the one hand, this attests to the fact that sustained core support from CIDA/Canacla, USAID/OFDA, and specific contributions from other donors has enabled PAI-IO_O to raise the level of interest and commitment in the countries. On the other hand, it has forced PAHO_O and theEmergency Preparedness Program management to constantly review priorities, sharing attention and resources with new areas in need of promotion and support.
